Bacterial meningitis in horses *H&H VIP*

Last Christmas, the Wayland family prepared themselves for the worst. After 10 days of providing round-the-clock care for Jerry, their seriously ill Connemara gelding, it seemed as if he was losing the battle.

“His head had started to tilt until it was twisted, while his left eye had dropped in its socket so you could only see the white part,” recalls Sarah Wayland. “He then stopped eating and drinking and was struggling to stand. We had to make a decision — put him down or carry on.”

Jerry was fighting bacterial meningitis, an infection that causes inflammation of the membranes — “meninges” — that surround the brain and spinal cord. The condition affects the horse’s central nervous system, resulting in neurological problems including loss of balance, muscle spasm and paralysis. It is incredibly rare and typically fatal.

After discussing euthanasia options with her daughter, Tia, and the attending vet, Sarah felt that Jerry deserved one last chance. Her instinct proved right. The road to recovery was lengthy and often challenging, but the 16-year-old gelding can count himself among the few known equine survivors of the disease.

Emergency measures

Signs that something was amiss had first emerged earlier that month, when Jerry was taken to Towcester Equine Vets for a final gastroscope after treatment for gastric ulcers.

His temperature had risen in reaction to the sedative, while an abnormally high level of white blood cells in a blood sample indicated some sort of infection.

“Tia had ridden him the day before and he was fine,” says Sarah. “We took him home with some antibiotics and instructions to rest him, but two days later he seemed to lose his balance. The vet came straight out and confirmed that the infection was affecting his neurological system.”

Jerry was given a steroid injection to reduce inflammation, but later that night his condition deteriorated dramatically.

“It was decided that he should go to Newmarket Equine Hospital [NEH] for intensive care, but he was puffing and shaking so much that he wouldn’t load,” says Sarah, recalling the efforts of a large team of vets and helpers to get him onto the lorry.

Towcester Equine vet Becky Price MRCVS says: “When we visited Jerry as an emergency call-out, he was in a bad way. He was trembling and neurologically challenged both centrally and peripherally — he didn’t know where his legs were. We tried to stabilise him with sedatives and muscle relaxants but he couldn’t travel. We had to bring the hospital to him.”

Supportive ropes and intravenous (IV) lines were hung from the stable rafters, while Becky worked with NEH specialists to pinpoint the problem.

“It was obvious from Jerry’s blood tests that we were dealing with something pretty significant, although we had ruled out infectious conditions such as strangles and equine herpes,” she says. “Diagnosis for bacterial meningitis involves a spinal tap — taking a sample of the CSF [cerebrospinal fluid] surrounding the spinal cord to test for evidence of infection. This is a risky procedure, however, especially when conditions are not sterile, and can even be fatal.

“We suspected bacterial meningitis because of the way Jerry was responding to therapy,” adds Becky. “The prognosis was very guarded as survival rates are extremely low.”

Jerry required twice-daily veterinary attention and intensive nursing. He was fitted with an IV catheter and a drip, to prevent dehydration and provide cardiovascular support.

“We had to change his IV fluid bags every two hours, day and night, so we camped beside his stable in the yard owners’ lorry,” says Sarah, who remains indebted to Sam Lennard and Barry Grout of Castle Farm Equestrian in Warwickshire for their hands-on support. “We went home for two hours on Christmas Day, but otherwise we didn’t leave him.

“The following night, when he really went downhill, we wondered if enough was enough,” she adds. “So many tears were cried. We said goodbye a number of times.”

The pony battled on, however. Sarah and Tia pushed tiny amounts of chopped-up hay and water into his paralysed mouth so that he could chew. As the infection subsided, he slowly gained strength, until he could at last come off the antibiotics, painkillers and IV treatment.

‘He looked drunk’

As they finally started to believe that Jerry might survive, the Waylands wondered what sort of pony they would be left with.

“When he took his first few steps out of the stable, three months later, he looked drunk,” says Sarah. “He needed two people to help him in front and another behind to hold his tail and steady him, but we kept walking him to his field and back every day so he could get used to being outside again. It was a scary moment when we eventually turned him out, but he was fine,” she added.

“I’ve not seen a horse so badly affected that has pulled through to this stage,” says Becky, who has been amazed by Jerry’s progress. “He had neurological deficits, such as a head tilt and eye droop, and weakness on his left-hand side, and it takes time for these pathways to redevelop. But he is now lungeing in walk, trot and canter, trotting over poles and enjoying time in the paddock.”

With regular physiotherapy sessions and steady groundwork, it is hoped that Jerry will be hacking out under saddle by the end of the year. For the Waylands, the greatest reward is seeing his personality re-emerge.

“Jerry is a massive part of our family,” says Sarah. “He could jump 1.05m before, but I can’t imagine that again. But they’re calling him the miracle horse, so who knows? A few months ago, we never thought he would be out in a field again.”

Q: What causes the condition?

“In adult horses, the most common cause is direct exposure of the meninges to bacteria,” says Dr Mark Hillyer of Newmarket Equine Hospital, who provided specialist support in Jerry’s case. “This can occur as a result of trauma and fracture to the head, or as a consequence of diseases of the paranasal sinuses.

“Clinical signs are subtle in the early stages, but an altered mental state, lack of co-ordination or both are typically seen as the condition progresses.”

Becky Price adds: “Jerry had a raised temperature but was otherwise bright and showed no particular signs. Why he developed bacterial meningitis remains a mystery.”

Q: How rare is it?

“Bacterial meningitis is extremely uncommon in horses,” says Mark, pointing out that in the UK we are currently fortunate not to suffer from the viral causes of meningitis and brain disease seen elsewhere, such as West Nile virus, Eastern and Western encephalitis and even rabies.

A lack of bacterial meningitis cases means that there is little by way of research findings or data, but survival rates are thought to be as low as 5%.

Q: Can it spread?

“It is unlikely to spread between horses, and less so to other species,” says Becky. “We were careful with biosecurity, however, isolating Jerry as well as we could and maintaining strict hygiene standards. The other horses at the yard were monitored, but none showed any signs of infection.”

Q: Are there any preventative measures?

Becky advises: “It’s good to know the parameters for your horse’s vital signs, such as his heart rate, and to take his temperature daily so you know what is normal if anything changes. While bacterial meningitis is incredibly rare, prompt treatment will enhance chances of survival.”

Ref Horse & Hound; 12 July 2018